When teaching cast care, the nurse instructs the client to:
A. Blow dry the wet cast on the "hot" setting
B. Report changes in sensation or mobility to the area
C. Use only soft objects to slide down the cast for scratching
D. Cut away the edges of the cast if the skin becomes irritated
B
B. Client must monitor neurovascular status, paying particular attention to blueness or paleness of nails, pain, feeling of tightness, numbness, or tingling sensation.
A. Caution client against drying wet cast with hair dryer; this can cause plaster to crack or skin underneath to be damaged.
C. Client should avoid sticking objects down or in cast to scratch, because these objects can cause breaks in underlying skin and subsequent infections.
D. Small pieces (petals) of adhesive tape 2.5 to 5.0 cm (1 to 2 inches) are cut and taped smoothly over edge of cast.
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The nurse is observing a patient learning to use crutches. Which observation would prompt the nurse to reinforce teaching about crutch walking?
1. The axillary crutches have been sized so they do not touch the patient's axilla. 2. The patient using axillary crutches places the weight on the palms of the hands when walking. 3. The cuff of the patient's forearm crutch fits just above the elbow. 4. The patient places only part of the weight on forearm crutches.
A client is admitted with trauma of the XII cranial nerve. This injury could cause the client to have difficulty:
1. Speaking. 2. Hearing. 3. Tasting. 4. Smelling.
A student in the last semester of nursing school has established a goal of making a successful role transition to graduate nurse. Which statement by the student indicates his/her understanding of how to achieve this goal?
a. "I should care for increased numbers of patients to enhance work organization skills.". b. "I will observe staff nurses as they per-form nursing procedures to refine tech-nique.". c. "I should seek increasingly close guidance from the nursing instructor to reduce er-rors.". d. "I will evaluate my progress every 7 weeks or more to allow time for growth.".
A client with heart disease who had a myocardial infarction 2 months ago comes to the clinic for a follow-up visit
While assessing the client, the nurse would be alert most likely for the development of which of the following responses? Select all that apply. A) Personality disorder B) Depression C) Substance abuse disorder D) Anxiety disorder E) Delirium